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Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality

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  • Alain Gagnon
  • Matthew S Miller
  • Stacey A Hallman
  • Robert Bourbeau
  • D Ann Herring
  • David JD Earn
  • Joaquín Madrenas

Abstract

The worldwide spread of a novel influenza A (H1N1) virus in 2009 showed that influenza remains a significant health threat, even for individuals in the prime of life. This paper focuses on the unusually high young adult mortality observed during the Spanish flu pandemic of 1918. Using historical records from Canada and the U.S., we report a peak of mortality at the exact age of 28 during the pandemic and argue that this increased mortality resulted from an early life exposure to influenza during the previous Russian flu pandemic of 1889–90. We posit that in specific instances, development of immunological memory to an influenza virus strain in early life may lead to a dysregulated immune response to antigenically novel strains encountered in later life, thereby increasing the risk of death. Exposure during critical periods of development could also create holes in the T cell repertoire and impair fetal maturation in general, thereby increasing mortality from infectious diseases later in life. Knowledge of the age-pattern of susceptibility to mortality from influenza could improve crisis management during future influenza pandemics.

Suggested Citation

  • Alain Gagnon & Matthew S Miller & Stacey A Hallman & Robert Bourbeau & D Ann Herring & David JD Earn & Joaquín Madrenas, 2013. "Age-Specific Mortality During the 1918 Influenza Pandemic: Unravelling the Mystery of High Young Adult Mortality," PLOS ONE, Public Library of Science, vol. 8(8), pages 1-9, August.
    • Handle: RePEc:plo:pone00:0069586
    DOI: 10.1371/journal.pone.0069586
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    References listed on IDEAS

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    1. Justin Lessler & Steven Riley & Jonathan M Read & Shuying Wang & Huachen Zhu & Gavin J D Smith & Yi Guan & Chao Qiang Jiang & Derek A T Cummings, 2012. "Evidence for Antigenic Seniority in Influenza A (H3N2) Antibody Responses in Southern China," PLOS Pathogens, Public Library of Science, vol. 8(7), pages 1-11, July.
    2. Darwyn Kobasa & Steven M. Jones & Kyoko Shinya & John C. Kash & John Copps & Hideki Ebihara & Yasuko Hatta & Jin Hyun Kim & Peter Halfmann & Masato Hatta & Friederike Feldmann & Judie B. Alimonti & Li, 2007. "Aberrant innate immune response in lethal infection of macaques with the 1918 influenza virus," Nature, Nature, vol. 445(7125), pages 319-323, January.
    3. Myrskylä, M. & Mehta, N.K. & Chang, V.W., 2013. "Early life exposure to the 1918 influenza pandemic and old-age mortality by cause of death," American Journal of Public Health, American Public Health Association, vol. 103(7), pages 83-90.
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